OFFICE USE ONLY
File Number:
Application Number:
APPLICATION TO UNDERTAKE ACTIVITIES OR WORKS IN THE DAMPIER TO BUNBURY
NATURAL GAS PIPELINE CORRIDOR
Section 41 Dampier to Bunbury Pipeline Act 1997 (DBPA)
Any unauthorised use of the DBNGP corridor is an offence and attracts a penalty under section 41(4) of the DBPA and Regulation 4A of
Corridor Regulations. A successful criminal prosecution under these provisions can result in substantial fines.
SECTION 1: APPLICANT DETAILS
All fields marked * are mandatory and must be completed before the application is submitted
Full name*
Position title*
Company name* (if applicable)
Postal address*
Suburb/Town*
State*
Post code*
Phone*
Mobile*
Fax
Email*
SECTION 2: RESPONSIBLE PARTY (may be the applicant or party who is requesting for the work to be done)
Full name*
Position title*
Company name* (if applicable)
Postal address*
Suburb/Town*
State*
Post code*
Phone*
Mobile*
Fax
Email*
SECTION 3: FINAL PERSON COMPLETING WORKS ON SITE
(may be applicant, responsible party, third party contractor or other persons)
Full name*
Position title*
Company name* (if applicable)
Postal address*
Suburb/Town*
State*
Post code*
Phone*
Mobile*
Fax
Email*
Fax to (08) 6552 4417 OR email to [email protected]
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SECTION 4: WORK SPECIFICATIONS
Location of works
Dial Before You Dig enquiry number or s41 Approval reference (if applicable)
Example - SEQ 16316929 (DBYD) or s41_258 (s41 Approval reference)
Proposed start date*
Type of work (please select)*
Proposed finish date*
Temporary
Permanent
Work site address (include Certificate of Title or Land Record number, if known)*
Certificate of Title Volume _________ Folio _________/ Land Record Volume _______ Folio _______
Address and location of proposed works crossing the DBNGP corridor
Side of the street* (N, S, E, W)
Distance from and name of nearest intersection*
Location type i.e. Private property, Road reserve*
Source of map i.e.
StreetSmart
Travellers Atlas
Map page and
Grid reference
GPS Coordinates*
Datum ________________ MGA
Area 1 -
(Easting) _________________ (Northing) ______________
Area 2 -
(Easting) _________________ (Northing) ______________
Area 3 -
(Easting) _________________ (Northing) ______________
Area 4 -
(Easting) _________________ (Northing) ______________
Area 5 -
(Easting) _________________ (Northing) ______________
Area 6 -
(Easting) _________________ (Northing) ______________
If you need a map to better identify the location of proposed work in relation to the DBNGP corridor, please
contact 6552 4400 (ask for Infrastructure Corridors team)
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Fax to (08) 6552 4417 OR email to [email protected]
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Full description of work planned within the DBNGP corridor (if sending electronically please attach available plans in
.pdf format and any additional information as a Word document)
Please tick all boxes that apply TYPE OF ACTIVITY
 Application is related to DBP Looping project - reinstatement of facilities and/or improvements.
 Landowner - maintenance/improvements on property.
 Building Approval Number _______________ (only activities relating to dwelling additions, extension/
alterations, patio pergola retaining wall and/or outbuilding installations, demolition, private pool installation and
any earthworks incidental to these activities). Please attach application.
Part 2 Division 2 of the Building Act 2011 states that a written application must be submitted to the
local government authority for a licence before the above stated activities can be allowed to
commence. Please contact the relevant local government authority for further advice if required.
 Major Project under _________________________________(Government Department/ Private company/ Other)
 Preliminary investigation & design phase
 Approval phase
 Construction phase
 Implementation phase
 Minor Project under _________________________________(Government Department/ Private company/ Other)
 Preliminary investigation & design phase
 Approval phase
 Construction phase
 Implementation phase
 Proposed works are approved by WAPC Development Application number ___________Please attach application.
Any development proposal outside the DBNGP corridor must take into account Planning Bulletin 87 which can
be found at http://www.wapc.wa.gov.au/Publications/1482.aspx
 Other - Please specify _________________________________________________________________________
DETAILS OF PROPOSED WORKS
 Construction Site - erection of structures including poles, towers, concrete slab - _______________________
 Depositing fill - ______ mm over existing surface. Type of fill _______________________________________
 Excavation - _________________________________ mm over existing surface.




Trenching Activities. Please indicate depth of soil disturbance ________mm
Horizontal Directional Drilling. Please indicate depth of soil disturbance ________mm
Directional Drilling. Please indicate depth of soil disturbance ________mm
Vertical Boring & Drilling. Please indicate depth of soil disturbance ________mm
 Road resurfacing and maintenance. Depth of soil disturbance _____mm Proposed surface__________________
 New road construction. Depth of soil disturbance _____________mm Depth of material removal ________mm
Proposed surface__________________
 Road upgrade. Current Surface ______________ Proposed Surface____________
 Driveway construction / resurfacing. Please indicate the type of vehicle _________ and weight _____tonnes per

axle and indicate depth of soil disturbance __________mm
Vehicle crossing. Please indicate the type ___________ of vehicle and weight _________ tonnes per axle
 Railway works. Upgrade/ Construction. Please indicate depth of soil disturbance __________________mm
 New fence construction/ replacement. Type and Material - ____________________________ Height______
Footing dimensions ___________mm deep ________mm wide
 Driving of post & stakes
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Fax to (08) 6552 4417 OR email to [email protected]
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 Wall construction. Type and Material - __________________________________________. Height___________
Footing dimensions ___________mm deep ________mm wide
 Paving - Material ____________________ Depth of digging ________________mm
 Compaction activity. Type of Machinery _______________
 Electrical Cable installation. Please indicate voltage of cable - __________voltage Depth of cable _______mm
 Installation of overhead transmission lines. Existing/New Hole required? ___________
 Replacing power poles. Existing/New Hole required? ________




Reticulation. Please indicate depth of pipe ____________mm
Water Pipe installation. Please indicate diameter of pipe - ___________mm Depth of pipe ___________mm
Drainage installation. Please indicate depth of drainage - ___________mm Depth of drainage ___________mm
Sewer Pipe installation. Please indicate diameter of pipe - __________mm Depth of pipe ___________mm
 Landscaping - Type of vegetation - _____________________ mm (300mm is maximum root depth) Type that has
a root depth of greater than 300mm can pose a threat to the pipeline. Tree roots that wrap around the pipeline can
split the protective coating allowing corrosion to take place.
 Firebreak activity - Slashing vegetation to height of ________________mm/ inches
 Potholing / Test holes - Depth ______________mm
 Entry for the purposes of conducting Survey type activities (no digging)
 Registration of interest (i.e. Easement/ Restrictive Covenant/ Leases) on Certificate of Title Volume _______
Folio ___________
 Telecommunications cable installation under Commonwealth Legislation - Clauses 17, 18 and 19 of Schedule 3 to
the Telecommunications Act 1997.
 Other activity - please describe type of activity _____________________________________________________
Please indicate length, width and depth of activity area* -
Please state the type 'and weight’ (if exceeding 10 tonnes per axle) of Machinery or Equipment to be used for works
within the DBNGP corridor*
1. (Type) ___________________________________________________________ (Weight) _____________tonnes
2. (Type) ___________________________________________________________ (Weight) _____________tonnes
3. (Type) ___________________________________________________________ (Weight) _____________tonnes
4. (Type) ___________________________________________________________ (Weight) _____________tonnes
5. (Type) ___________________________________________________________ (Weight) _____________tonnes
6. (Type) ___________________________________________________________ (Weight) _____________tonnes
7. (Type) ___________________________________________________________ (Weight) _____________tonnes
Continue on pg 5
Fax to (08) 6552 4417 OR email to [email protected]
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Please provide any further details of the proposed Works Procedure or Construction Method in the space below*
Please indicate intended future use or activity of the land i.e. - permanent crossing, storage facility, etc.*
Type of activity
Further information  Any maps or drawings identifying where you intend to access/cross the DBNGP corridor should be included and
form part of this application.
 Once the department receives the signed application, the department will request the Access Right Holder for
comment and technical conditions to ensure that the proposed works are carried out in a safe and appropriate
manner within the DBNGP corridor. Depending on the complexities of the proposal, this may take up to 10 - 14
days.
 The applicant also needs to take into account the time it will take to arrange for the inspection services required to
satisfy technical conditions for the works to commence. This may take up to another 10 - 14 days to arrange.
 The timeframe from when your application is first submitted and when a DBP officer can be onsite to supervise
the work may extend to approximately 21 days. It is beneficial to take this into account in the preparation stages
of your works.
I acknowledge that all grants of conditional approval will at all time be subject to the rights granted to
pipeline operators under section 34 of the DBPA. Should future pipeline operations impact on the
approved Works then I may be required to remove, realign or modify any facilities established on the
Access Area at my cost.
I understand that the Minister may grant the approval under section 41 of the DBPA on condition that I
execute and return the Deed Poll of Indemnity to the department before the application is processed.
The department will notify the responsible party of the outcome of the application after assessment.
Signature of Applicant ____________________________________
Date
________________________
Full Name & Position Title: ______________________________________________________________________
Fax to (08) 6552 4417 OR email to [email protected]
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